Provider Demographics
NPI:1285968628
Name:PRECISION VISION
Entity type:Organization
Organization Name:PRECISION VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GNANAKKAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:602-770-9300
Mailing Address - Street 1:4000 OLD COURT RD STE 204
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6415
Mailing Address - Country:US
Mailing Address - Phone:410-653-2400
Mailing Address - Fax:410-653-2402
Practice Address - Street 1:4000 OLD COURT RD STE 204
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-6415
Practice Address - Country:US
Practice Address - Phone:410-653-2400
Practice Address - Fax:410-653-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD332252Medicare PIN